1114118171 NPI number — ZOOMX MOBILE DIAGNOSTIC SERVICES, LLC

Table of content: LAWRENCE F. GALLAGHER D.M.D. (NPI 1851452957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114118171 NPI number — ZOOMX MOBILE DIAGNOSTIC SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZOOMX MOBILE DIAGNOSTIC SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ZOOMX
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114118171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30230 ORCHARD LAKE RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48334-2267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-538-9444
Provider Business Mailing Address Fax Number:
248-851-8585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30230 ORCHARD LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48334-2267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-538-9444
Provider Business Practice Location Address Fax Number:
248-851-8585
Provider Enumeration Date:
08/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EISENBERG
Authorized Official First Name:
LEO
Authorized Official Middle Name:
SAUL
Authorized Official Title or Position:
MEMBER/MANAGER
Authorized Official Telephone Number:
248-538-9444

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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